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December 9, 2016

There are many aspects of the nursing profession people prefer not to discuss. One topic I've corresponded privately with nurses nationwide involves the emotional cost of being a nurse. I get countless messages about this and have found that it affects nurses across the spectrum. It has nothing to do with your institution, work experience, or educational background. It has to do with the profession itself. Each job has its own unique set of issues. But the medical profession has a distinct one, mortality. With each code blue, there is an understanding that the human body can only take so much stress and that the choices we make matter significantly. These are the thoughts that stick with medical professionals and cause an emotional strain for some. We, as nurses, participate in intense moments of crisis and each occurrence has the potential to change us in some way.

When I was in nursing school, I don't recall anyone every considering the emotional aspect of someone dying or becoming permanently injured. These situations were often presented as "interesting" cases during lectures or clinicals. The educational perspective provided a type of distance, which made it fictional on some level. These encounters had your heart racing and curiosity ignited. It was something you observed but you never truly understood the ramifications of what was happening. I was educated on vital signs, cardiac arrest, and the physiological aspects of death. But I had no course on managing my feelings before, during, or after cardiopulmonary arrest events. There was no seminar on how to approach a wife and explain to her that her husband of 30 years had just died. I, as a nurse, never made this notification. But, I was often the first person to be introduced during the situation. I was the first medical professional the wife saw, the first point of contact. Do you know how hard it is to say nothing when you know everything? It's difficult, beyond words. This patient occupied a brief moment in your life but he was a spouse and father to others. Decades of relationships and connections existed, to now be lost forever. It's tough to see the destruction of a family and then clock out, go to the grocery store and get your own family some dinner. It's an odd juxtaposition.

With each encounter, you learn something about yourself, humanity and the human condition. It's sobering and allows you the ability to sincerely appreciate your life and loved ones. The effects of death don't solely impact the patient's loved ones. It can linger with medical personnel from minutes to years. For all the nurses who struggle with this emotional toll, understand that only you can process how you feel. If this emotional strain begins to cause dysfunction in your life, you might need professional help in the form a therapist or counselor. You determine nursing's influence and significance in your life. It can be positive or negative, but only you can ascertain the intention of what you've experienced. We, as nurses, help our community in times of crisis. Don't allow those times of crisis to negativity impact your life and relationships.

Category: Fundamentals The most common symptom of patients with left-sided heart failure is shortness of breath, chiefly exertional dyspnea at first and then progressing to orthopnea, paroxysmal nocturnal dyspnea and rest dyspnea.

December 6, 2016

Regardless of nursing specialty or work location, a large number of nurses administer medications in some form or fashion. From oral to intravenous, there is a multitude of drugs that patients are expected to take during the disease management process. One continuing goal throughout my profession is to understand the inner workings of drugs, as many problems derive from the lack of knowledge in pharmacology. Drug framework, timeline and side effects are topics nurses should have some level of expertise in. For those who had or are having a problem with medication education, I hope my suggestions help in your medicine wisdom.

Drug Framework

As a new nurse, I often cared for patients who took five to ten medications during the morning medication pass. For example, a patient would take lisinopril, metoprolol, and carvedilol at 9 A.M. As a nurse, I knew all these medications were cardiac in nature, but there was a lack of understanding concerning the drug's performance. Often, either pharmacy or the provider will provide a reason for use, along with parameters. These instructions often include verbiage such as, hold medication(s) if the SBP is less than 120. The purpose of these drugs, in this case, was the management of hypertension. If these drugs were administered, and the patient had borderline hypotension pre-drug administration, the result would be profound hypotension and the need for supportive measures post-drug administration (e.g. bolus or vasopressor). As nurses, we must comprehend the goal of drug therapy and factors that could potentially halt treatment. If your institution doesn't provide parameters of administration, as nurses, we must do our research and understand the drug's indication of use. If a drug causes a decrease in SA nodal conduction, there will be a reduction in the heart rate. Knowing the physiological effects of the medicine you are administering is crucial toward understanding its purpose.

Drug Timeline

After you understand the drug's purpose and effects, it's time to examine the timeline regarding the drug's half-life and excretion details. When a patient discontinues a drug, the combination of metabolism and excretion will cause a decline of the drug in the body. The half-life of a drug is an indication of how quickly that decline occurs. Drug half-life is defined as the time required for the amount of drug in the body to decrease by 50%. The half-lives of medications can range from minutes to upwards of one week. For example, the half-life of morphine is three hours. By definition, this means that the body stores of morphine will decrease by 50% every three hours, regardless of how much morphine is in the body. If there is 50 mg of morphine in the body, 25 mg (50% of 50 mg) will be lost in three hours. If there is only 2 mg of morphine in the body, only 1 mg (50% of 2 mg) will be lost in three hours. Understanding a drug's half-time is crucial for dosage intervals and intravenous rate titration. Oh and let's not forget excretion. Drug excretion is defined as the removal of drugs from the body. Drugs and their metabolites can exit the body in forms of urine, bile, sweat, saliva, breast milk, and expired air. The most important organ for drug excretion is the kidney. So, if a patient has a body or fluid dysfunction in any of the areas mentioned above, drug excretion may be altered.

Drug Side Effects

After the drug's indication and timeline are understood, we can move to potential side effects. Once a medication is administered, there can be unwanted side effects. Common side effects include nausea, vomiting, and diarrhea. If these symptoms present themselves minutes or hours after medication administration, the medication could be the culprit. The goal is to understand the primary cause of these new symptoms in order to provide a quick remedy. For example, a patient is administered an antibiotic. During administration, he or she becomes nauseous. Your first step should be to confirm if the antibiotic could cause nausea or if it is unrelated and needs further investigation. If the antibiotic is the cause, discontinuing the medication should relieve the symptoms and an antiemetic could be provided. But if the drug isn't linked to nausea, a focused gastrointestinal assessment may be necessary. The goal is the provide prompt care and knowing the cause does that. Providing a patient with a list of potential side effects is important. It offers the patient the ability to make an educated healthcare decision.

Drug Resources

That is it, seems like a lot huh? Luckily there are many drug applications on the market used to help medical professionals in obtaining this type of information fast. I've used my smartphone during my nursing career and found all the above information with a simple touch of the screen. The following are amazing drug applications that provide extensive information regarding the topics mentioned above:

Category: Fundamentals Sudden cardiac death is defined as unexpected nontraumatic death in clinically well or stable patients who die within 1 hour after onset of symptoms. The causative rhythm in most cases is ventricular fibrillation.

December 5, 2016

Category: Fundamentals Torsades de pointes, a form of ventricular tachycardia in which QRS morphology twists around the baseline, may occur in the setting of severe hypokalemia, hypomagnesemia or after administration of medicine that prolongs the QT interval.

December 4, 2016

Category: Fundamentals Ventricular tachycardia is defined as three or more consecutive ventricular premature beats. The usual rate is 160-240 beats per minute and is moderately regular but less so than atrial tachycardia.

December 3, 2016

Category: Fundamentals Chronic atrial flutter is often difficult to manage, as rate control is challenging. If pharmacologic therapy is chosen, amiodarone and dofetilide are the antiarrhythmics of choice. Dofetilide is often given in conjunction with an AV nodal blocker.

Congratulations, you have successfully finished nursing school. I know, you're already stressed about your upcoming NCLEX-RN® examination. You're almost at the finish line and the only thing standing between you and a flawless victory is this exam. You've made it through nursing foundations and the nursing techniques courses. You've even perfected insulin administration and giving medications through nasogastric tubes. And now it's time to use that expertise toward analyzing and interpreting various nursing-based performance scenarios. This is a six-week game plan on passing the NCLEX-RN® exam.

BODY SYSTEMS - ONE WEEK

Time Dedication: 2 - 4 Hours Per Day

Activities: Reading & Taking Notes

Before we get into practice questions, I recommend each individual purchase a book (or a credible online resource) that breaks down each body system in great detail. Before we get into infections and disease processes, we need to understand the baseline of the human condition. I'm talking about S1, S2, what these mean and where they're located. I'm talking about the legit foundations. Even if you're fresh out of nursing school, you need this refresher.Body systems are the starting point and this section will assist you in understanding the typical clinical presentation. When you know what the norms are, finding abnormal clinical manifestations are a breeze. If you know that normal urine output is at least 30 ml/hr and your patient produces only 10 ml/hr, you know something is wrong. That intuition, that critical thinking, all stems from you understanding body systems and how they function.

When I was in nursing school, I purchased a book titled Saunders Comprehensive Review for the NCLEX-RN® Examination. This book broke down each body system in outline format. What I enjoyed most about this book was the body systems evaluation. In the cardiology section, it went over heart sounds, locations, and subsequent expected outcomes. This text disseminated information in a structured manner. It started from basics and went into the intricate dynamics of nursing. I recommend this book, but any book that can accomplish this goal will work. The goal is to purchase or rent a resource that will assist you in understanding each body system in its entirety. You will not know why certain sign and symptoms of hyperkalemia present themselves if you don't understand what the body does with potassium on a cellular level. You can't run before you walk. All the boring stuff has to be understood in order to move onto the gross and cool stuff.

DISEASE PROCESSES - TWO WEEKS

Time Dedication: 2 - 4 Hours Per Day

Activities: Reading & Taking Notes

We've made it to the second week and now it's time to apply your nursing foundations to abnormal conditions. You know about S1 and S2, but what if you hear S3? What does that mean? What nursing interventions are expected? This is the meat and potatoes of the NCLEX-RN® examination. Many questions revolve around nurses analyzing a situation and determining what the next assessment or action will be. This is nursing in a nutshell. You think you're going to get tested on what S1 and S2 signify? Umm, no. Your state nursing board wants to know that you can safely care for ill individuals. You can't test someone's critical thinking skills by asking questions about healthy people in routine circumstances. The NCLEX-RN® exam isn't about health people in optimal settings, who require no medications or interventions. It's about the people who will need you, the sick and the ill.

This segment will take twice as long as foundations because the cardiovascular system is the same for everyone (in most cases). The pipes are the same and their functions are the same. But, heart failure has many classes and presentations, along with different symptoms within diverse age groups. To successfully understand this section, you will need to dedicate a good amount of time toward discerning conditions found in each body system. Yeah, this isn't sexy or entertaining. But again, we must build upon the foundations in order to be ready for the practice questions section. As mentioned earlier, the Saunders Comprehensive Review for the NCLEX-RN® Examination book is a great resource, with an outline format on disease processes too.

PRACTICE QUESTIONS - TWO WEEKS

Time Dedication: 1 - 2 Hours Per Day

Activities: 50 - 75 Questions Per Day

You've made it to the promise land! Your hands hurt, you're exhausted from reading, and now it's time to apply what you've learned these past few weeks. Regardless of what route you take, you need find practice questions and a lot of them. Whether it's through programs such as Hurst, Kaplan, or from a book, you need to practice. You must test your knowledge in order to find out if you've successfully grasped the content. It's one thing to take notes and read. It's another to analyze the information and accurately apply it on an exam. You could use the Saunders Comprehensive Review for the NCLEX-RN® Examination book, as it has practice questions at the end of each chapter. But I recommend either purchasing or renting last least 2-4 books. I found that each author brings his or her's nonpartisan perspective in the form of practice questions. It's in your best interest to use as many credible resources as you can in this section. Some books I found helpful include:

If you take an exam and get less than 75%, you did NOT understand the content thoroughly, and you need to revisit steps one and two. This section is about honesty and will require you to be realistic with yourself. You can't expect to get 30% on all your practice exams and then walk into the NCLEX-RN® exam assuming you will ace it because you understand all the aspects of nursing care. Clearly, there is a disconnect somewhere and you need to revisit some parts of your study material. If you invest in yourself, you will be successful. The preparation will pay off, the long nights will pay off. Ignoring what you don't know will only cause problems. If you don't understand why you keep getting renal failure questions wrong, you doing more renal failure practice questions won't educate you on the matter. You need to go back to body systems. You shouldn't test yourself on concepts that are unfamiliar to you, it's a waste of time. You need to go back, review your notes and find the gaps in your education. It's annoying but necessary. Please don't skip this step, this is where the rubber meets the road. You can do all the practice questions you want. Eventually, your memory will kick in and you will start getting better scores. But you haven't really learned anything, you're just going off sheer memory. The goal of practice questions isn't to do the same test 20 times until you get a 100%. The goal is to test your knowledge and find potential gaps.

BONUS STEP

Medications & Pharmacology

This is a tough subject for some and it requires its own mention. When it comes to medications, you will likely be asked about expected outcomes (e.g. lowers blood pressure, relieves headaches), potential side effects (e.g. nausea, abdominal pain), and nursing related implications (e.g. monitor for heart block or dysrhythmias). My advice to you is to first group medications by their drug class (e.g. beta-adrenergic blockers, selective serotonin re-uptake inhibitors). This will enable you to classify drugs with similar names (generic names) and allow for faster identification. After grouping, you can then go into the expected outcomes and associated side effects. Most medications within the same drug class tend to have similar side effects, so grouping them will make this pattern easy to recognize. One company who has the medication game on lock is the NRSNG.com organization. They offer tons of information about drugs and pharmacology commonly presented on the NCLEX-RN® exam. Here are some links:

So yeah, that is it. It's time-consuming, I know. But you passing this exam will determine your future employment status and the course of your nursing career. Don't sleep on the importance of preparation. When you walk into an exam cold and unprepared, you usually don't do so well. But every time I've truly dedicated myself to a plan, it never went sideways on me. I went into the exam calm and capable. I hope you can too using this strategy. I wish you the best of luck and I can't wait to work alongside you!

December 2, 2016

Category: Medical Surgical Nursing If antiarrhythmic or rate-control medications fail to improve the symptoms of atrial fibrillation, catheter ablation of foci in and around the pulmonary veins that initiate atrial fibrillation may be considered.

December 1, 2016

We all have been there. You are trying your best, and someone at work says something sarcastic or mean about a task you're performing. It seems benign but as time goes on, the taunts and joking turn into outright bullying. The jokes become more personal and direct. The jokes then evolve into overt signs of aggression. You then go from being an outgoing, efficient nurse to a quiet, skittish one who has anxiety every time you clock-in. That was me, I've been there. It wasn't until a friend said to me, "You need to say something, it's not getting better. You are breaking. You need to deal with this and stop trying to internalize it," that I realized just how much I was changing. Internalizing is your enemy, and it will eat at your potential as times goes on. Many nurses internalize their stress and end up either quitting the floor they work on or leaving the nursing profession entirely. You need to stand up for yourself in a professional manner and understand this is not your fault. As annoying as it is, it's solely up to you to resolve this problem. You don't get to sit back and hope it does away. The longer you ignore it, the worse it gets. It's like an infection, and we all know how bad infections can get if left untreated. Avoidance and being passive will only exacerbate matters. Here are some tips to help you with working alongside offensive nurses.

When a work associate is bullying you, you must stand up for yourself at that very moment. You should provide feedback at that moment and not wait. Whether the person listens to you or not, the feedback will stop the internalizing of negative feelings. You will no longer have to play the conversation back in your head over and over again, hoping you said this and wishing you said that. You simply approach it as a regular conversation and articulate how you feel. For example, if you make a mistake and someone says, "You're an idiot." You then can say, "I'm learning and your rude comment isn't helpful nor is it professional." The goal is to make the person aware of their unprofessional behavior while standing up for yourself at the same time. You don't need to stoop to their level in order to teach them a lesson in human decency. You simply need to verbalize how you feel. Two things could happen, either the bully understands you will no longer be a quiet victim and moves on, or the bullying continues. Either way, you made a move and expressed yourself. You have no idea how refreshing it is to stand up to a bully in a professional manner. It shows you're level-headed and you will not allow their behavior to deter you from being the best nurse you can be.

If you continue to stand up for yourself and it's ineffective, we move the defense up to management. No time frame needs to pass for you to proceed to managerial assistance. Verbal abuse and bullying shouldn't EVER happen. The second you feel harassed, it's time to go to management. There might be miscommunications and mistakes from time to time but, calling someone an "idiot" isn't a mistake. It's a deliberate comment used specifically to hurt someone. Understand it's in our human nature to downplay our feelings and second-guess them. We want to believe everyone in the world is kind and perhaps we're confused. If your feelings are wishy-washy, wait until you're certain. But understand that bullies use this hesitation to their advantage, in hopes you brush these encounters off as meaningless. Your non-response is, in reality, a response. Your inaction can be interpreted as you being accepting with the current dynamic. Which in turn, encourages the bully to continue the current course of action.

When you approach management, please explain the encounters on a professional level. You need to provide specific examples and not mere generalities. You don't need to go into why you're not an idiot nor do you need to scream and cry. The goal isn't to make it personal. The objective is to explain that this behavior isn't professional, and its continuance will only divide the team. Managers are all about the team dynamic and people impacting that effort is a concern. You don't need to defend yourself or examine that you're a new nurse and learning. The focus should always remain on the acts of bullying themselves and how they're affecting you as a nurse. No one can take being berated, demeaned and teased for an entire 12-hour shift. I sure can't. Allowing this behavior will not make you stronger, trust me. Get the support you need and talk to management about your concerns. Don't be pessimistic about management, they are there to help. And yes, there can be situations where middle management is complicit in the abuse, and you might need to go to the human resource department for assistance. Each situation requires a unique approach but make sure you stay within your organizational chart and speak to the appropriate parties. Again, the goal is to shine a light on the bullying and not to throw a tantrum. Having an emotional incident will only create a distraction and water down your message.

Some people say, "older nurses eat their young" or "critical care nurses are always mean." I don't speak in generalities. What I do know is that people are people. Alpha-type personalities tend to tease people who allow it, people who say nothing. The world is full of undiagnosed, unstable individuals looking for the right victims. It has nothing to do with age, experience or department. It has to do with people finding vulnerable individuals and using that vulnerability to their advantage. Bullying feeds an aspect of the bully's ego. It's a sick cycle of acceptance and abuse. So when you say nothing, you feed the cycle over and over. Don't get it confused, nurses are great people but we are people. People who have their own faults and issues.

In the end, you must verbalize yourself and talk to management in order for this bullying behavior to change. Some individuals might say that these tips are extreme and unnecessary. But they probably haven't had someone bully them at the point where they contemplated quitting their job or leaving a profession they spent four years of college to enter. It's terrible, you feel terrible. Hell, terrible can't even describe how awful you feel. I love nursing, it's a passion of mine. I've wanted to a nurse ever since I was a little girl. And honestly, when I was a graduate nurse, I was a week away from saying screw it and leaving the profession for good. That's how powerful bullying can be. It's an emotional trigger that only you can stop. There are people in this world that can take something you love and turn it against you. Don't allow someone to take nursing from you. You've worked too hard to make it here. Stand up for yourself, speak to management, and continue to help your community.

Category: Medical Surgical Nursing Atrial fibrillation should generally be considered refractory if it causes persistent symptoms or limits activity despite attempts at rate control. This is much more likely in younger individuals and those who are active or engage in strenuous exercise.

November 30, 2016

I have been in critical care for over five years, and that experience brings about an abnormal normality when I hit the floor for work. When I get to work and look into my patients' rooms, I see machines, drains, lines, tubes, screens, and pumps. Each item expresses a particular set of values or numbers, with all articles presenting a full clinical picture. I see the patient twitching, the pumps buzzing and alarms sounding. It can be overwhelming for non-medical individuals. But not for me, because this is my foundation, my home. When a family member or loved one arrives, I always try to turn off that side of my brain and view it from a human perspective. Remember, this is possibly the worst day of this person's life. My goal is to respect that sentiment and not to neglect them. Over time, I created a system that helps me to explain what people see when they walk into the room. Here is my system:

Note: All the information is disclosed if the individual(s) are one of the following: next of kin, healthcare power of attorney, health care surrogate, spouse or significant other. If not, consent is given by the patient or family member to disclose such information. HIPAA is still in effect even if the patient is sedated and unconscious during your care.1. Introduction

Before I introduce myself, I ask for their name. The name request makes the experience personal and authentic. After obtaining their name, I introduce myself and ask if they have any questions. The goal is to allow them to lead the conversation. In a setting of medical chaos and uncertainty, this is a small amount of control. Following the opening, I offer a handshake or hug. Whether you're a daughter or friend, this is a rough moment in your life and sometimes a hug matters greatly. When my husband was in the hospital, I was numb. I was there intellectually but not emotionally. It wasn't until my husband's nurse gave me a hug and said, "Hi, I'm Amy." It melted something within me and allowed me the ability to see the situation for what it was. My husband had his chest opened up and heart repaired. It was a massive, scary event in my life and it was okay to feel that.

2. The Actual Visual

After the niceties, we move on to the patient. Who the person sees laying in front of them. Before I go off and explain the lines and pumps, we just talk. We discuss the patient's physical presentation. The discoloration, the bleeding, the paleness. We verbally go through a head to toe assessment (in laymen's terms). I try not to use medical terminology, and I try to keep it basic. Nothing else will make sense if we skip this part of the discussion. For example, a patient is admitted with severe sepsis. We will go over the clinical presentation concerning infection and what it does to the body (e.g. low blood pressure, hypothermia, skin discoloration). I want to explain the visual before I go into what supportive measures are in place. Mentioning a vasopressor will not make sense to the common person if you don't explain why it's needed in the first place (e.g. infections cause low blood pressure). Don't be robotic in your explanation, this is a human being in peril. Understand this patient is someone's brother, husband or uncle.

3. The Hidden Visual

Now, it's time to explain the supportive measures. Support measures include intravenous infusions, central or peripheral lines, drains, room monitors, machines, and medical equipment. Your job as a nurse is to explain this setting and for the viewer to understand it entirely. You don't need to say serosanguinous drainage or go over wedge pressures. You are simply explaining why things are where they are and why they're needed. Nursing isn't just about doing things. It's about revealing and illuminating. Nursing is a social profession. The first step is to explain the vital signs and their WNL (within normal limits) ranges. You move from the patient toward the external numbers reflected. Even if no one asks about it, I go over the vital signs. There is calmness that takes place when one understands what they are seeing. Anxiety and stress occur with the unknown. I try to explain it all and avoid that.

When you break down the infusions, drains, lines, screens, and medical equipment in the room, you are an anchor to that individual(s). You are not simply a nurse. You are a support system. Respect that role and educate. Don't get caught up in explaining alpha and beta receptors, keep it simple. "This medication improves your son's blood pressure. It keeps his blood pressure within an adequate range in order to supply blood to all of his organs. Without this drug (Levophed), his organs would shut down due to lack of perfusion."

4. The Team

The next step is to explain the consultations (specialties) and physicians on the case. I define their roles and how this case is a collaborative endeavor. For example, nephrology is working on your son's acute kidney injury and will be managing his continuous renal replacement therapy (CRRT). I will be the nurse administering the care at the bedside but the nephrologist will provide me with orders and direction of care. I explain that there will be many individuals walking in and out of the room and that this type of movement is normal. I emphasize that each specialty as a specific goal but the providers are working as a team for an optimal medical outcome of all body systems. I go on to say something along the lines of, this might seem like chaos but it's an intricate dance moving at a rapid pace. Meaning, critical care is about timing and catching things before they are permanent. We move quickly in order to save lives not because we don't care. We are all here for one goal and one person, the patient. We all have our strengths, and we are using said strengths to help your loved one survive this medical threat.

5. Conclusion

We have reached the end of the conversation, and it is overwhelming. You need to allow time for the individual(s) to absorb what you just said. I always say, "Do you need a moment to yourself? I know this can be overwhelming." Again, I'm putting the ball back in their court and allowing them to tell me what they need at this time. I always open and close the conversation with the individual(s) telling me what they need and not me telling them. I've had many family members in the hospital. They were admitted before I went into nursing school, while I was enrolled in nursing school and now that I'm a critical care nurse. Explanation and education were the only things that kept my family and myself sane and calm. Don't underestimate the power of general conversation. You might be a great nurse but what matters is what's untold and unsaid. This patient passing might momentarily haunt you but the effects will be with that family member for a lifetime. The unknown is what eats at people, don't be apart of that pain.

November 29, 2016

When I became a nursing student, a co-worker told me, "Do not display your home address when you apply for a nursing license. Information is power." I had no idea what this meant and asked for clarification. When you request a nursing license with the state of Florida, you can opt to display your work address or a post office box rather than showing your actual home address. Unlike some states, Florida displays an "address on record" for each registered nurse. You determine what address will be displayed, but an address is required. My co-worker went on to reveal that he had previously chosen to show his home address on his nursing license application. Six months into his nursing career, a patient became upset with him and threatened him. Management immediately reprimanded the patient, and the encounter ended with the nurse reassigned to another team. Sadly, the experience didn't end there, and patient's actions continued in other forms.

The patient found the nurse's address online, using the Florida board of nursing license search. Once the patient had this information, he then harassed the nurse for a full year before authorities could act. This story taught me that as a professional, there could be circumstances where individuals take your professional activities personally. As nurses, we don't create medical care plans nor do we have the authorization to prescribe medications. Medical providers (MD, DO, NP, PA) create healthcare plans and determine prescription needs. Some patients don't understand the nursing scope of practice and assume you will not help him or her because you choose not to. This attitude can lead to individuals acting rashly and doing things they wouldn't normally do. Healthcare is a very personal matter. Projection and displacement are common occurrences.

If you are in a state that allows you to register your work address or opt out of displaying your home address, I recommend you do this. Whether it's a patient who needs mental health assistance, or an individual who lacks understanding, information is power. Power in the wrong hands can lead to heinous acts. We all have had moments where our emotions got the best of us, and we acted impulsively. Human nature is a convoluted process with conclusions and assumptions influencing us. Even if you've never experienced harassment or workplace violence, this preventive measure could hopefully prevent this type of thing from entering your life.

In my nursing career, I've treated criminals who had charges ranging from sexual assault, murder, drug trafficking and kidnapping. We are medical professionals, we care and treat individuals across the spectrum. When my home address was displayed (for a brief time) for the world to see, I received notes and letters from patients and their family members. It was inspiring and thoughtful. But not everyone in the world has good intentions. Some people want you to feel their pain and fixate on you as a target. Even if you have no such people in your life, this opting out could deter people from obtaining your personal information. It hopefully will prevent access into your life and access to your loved ones. I'd much rather have someone know where I work rather than where I lay my head to sleep. It's an intimate thing to know where someone lives, where their family lives. Be safe and be smart.

Category: Fundamentals Up to two-thirds of patients experiencing a first episode of atrial fibrillation will spontaneously revert to sinus rhythm within 24 hours. If atrial fibrillation persists or has been present for more than a week, spontaneous conversion is unlikely.

November 28, 2016

Category: Fundamentals If the onset of atrial fibrillation was more than 48 hours prior to presentation and early cardioversion is necessary due to inability to adequately rate control, a TEE should be performed prior to cardioversion to exclude left atrial thrombus.

November 27, 2016

Category: Fundamentals If the patient is hemodynamically unstable, usually as a result of a rapid ventricular rate or associated cardiac or noncardiac conditions, hospitalization and immediate treatment of atrial fibrillation are required.

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My name is Nacole Riccaboni.

I'm a registered nurse and I am passionate about nursing. I created a YouTube Channel directed at helping prospective, new and experienced nurses. Whether your dream is to be a nurse or you are enrolled in nursing school, I can help you be the best version of yourself. Look around, learn some stuff, message me and welcome.